Precision application of target-controlled infusion of esketamine combined with sufentanil in anesthesia for thoracoscopic surgery and its effect on hemodynamics, postoperative pain, and safety.

Abstract

We aimed to expound the precise application of target-controlled infusion (TCI) of esketamine combined with sufentanil in anesthesia for video-assisted thoracoscopic surgery (VATS) and its effect on hemodynamics, postoperative pain, and safety. Eighty patients scheduled for thoracoscopic procedures were randomly assigned to either a control group [n=40, conventional empiric anesthesia (sufentanil plus propofol)] or an observation group [n=40, TCI of esketamine and sufentanil]. Hemodynamic indices [mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), and oxygen saturation (SpO2)] were recorded before anesthesia (T0), after induction of anesthesia (T1), 30 min of anesthesia (T2), and at the end of surgery (T3). Recovery profiles [length of stay in the post-anesthesia care unit (PACU), awakening time], Ramsay sedation scores (T0-T3), visual analog scale (VAS) pain scores at 2, 24, and 48 h post-op, and adverse event rates were compared. The observation group showed smaller hemodynamic fluctuations from T1 to T3. At T3, this group had higher MAP, SV, and CO (P<0.05), steadier CVP and SVR, faster recovery (PACU stay and awakening times shorter, P<0.01), lower VAS scores at 24 and 48 h, higher Ramsay scores at T2 and T3, and lower overall adverse event rates (P=0.018) than the control group. TCI of esketamine plus sufentanil improved intraoperative hemodynamic stability, shortened recovery, enhanced early analgesia, and reduced adverse reactions in VATS, supporting its precision and safety.